Treat diarrhea-related fluid loss with oral rehydration salts; do not give antidiarrheal drugs to children under five
The priority with diarrhea is replacing lost fluid. Mix oral rehydration salts with water exactly as directed; sugary juice drinks are not a substitute and may worsen dehydration. Do not give children under five antidiarrheal medicines such as loperamide. Serious adverse effects include potentially fatal intestinal paralysis and obstruction.
What it takes
A box of oral rehydration salts costs a few to a little over ten RMB in China. Keep one at home.
What you may gain
The World Health Organization's diarrhea treatment manual states that antidiarrheal and antiemetic drugs offer no practical benefit in acute or persistent childhood diarrhea: they neither prevent dehydration nor improve nutrition. Some have dangerous and occasionally fatal adverse effects, and the manual says they must not be given to children under five. Drugs that slow bowel movement, such as loperamide, can cause severe paralytic ileus, which can be fatal, and may prolong infection. The manual also explains that very sugary drinks, including soft drinks and commercially prepared juice drinks, draw water into the bowel and can cause hypernatremic dehydration. It recommends a reduced-osmolarity oral rehydration formula with a total osmolarity of 245 mOsm/L. Compared with the older formula, this reduced unscheduled intravenous fluid use by 33%. A Cochrane review of eight trials found a similar effect, OR 0.59, 95% CI 0.45–0.79, or about 40% lower odds.
Context & considerations
Check the labeled osmolarity when buying the salts and choose a reduced-osmolarity formula. The manual says bloody diarrhea in children often indicates bacterial dysentery requiring medical assessment and antibiotic treatment; hydration alone at home is not enough. The medium benefit rating is a judgment: the numerical results compare two rehydration formulas, not rehydration with no rehydration.
Research & references
World Health Organization (2005). The treatment of diarrhoea: a manual for physicians and other senior health workers, 4th revision. https://iris.who.int/handle/10665/43209; Hahn S, Kim S, Garner P (2002). Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhoea in children. Cochrane Database of Systematic Reviews, (1):CD002847. https://doi.org/10.1002/14651858.CD002847